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J Knee Surg 2023; 36(13): 1380-1385
DOI: 10.1055/s-0042-1758772
Original Article

The Same Day Discharges following Primary Total Knee Arthroplasty: A Single Surgeon, Propensity Score-Matched Cohort Analysis

Christian Klemt
1   Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Wayne Brian Cohen-Levy
1   Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Meghan H. Pattavina
1   Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Bruna M. Castro De Oliveira
1   Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Akachimere Cosmas Uzosike
1   Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Young-Min Kwon
1   Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract

This is a retrospective study. As new surgical techniques and improved perioperative care approaches have become available, the same-day discharge in selected total knee arthroplasty (TKA) patients was introduced to decrease health care costs without compromising outcomes. This study aimed to compare clinical and functional outcomes between same-day discharge TKA patients and inpatient-discharge TKA patients. A retrospective review of 100 consecutive patients with same-day discharge matched to a cohort of 300 patients with inpatient discharge that underwent TKA by a single surgeon at a tertiary referral center was conducted. Propensity-score matching was performed to adjust for baseline differences in preoperative patient demographics, medical comorbidities, and patient-reported outcome measures (PROMs) between both cohorts. All patients had a minimum of 1-year follow-up (range: 1.2–2.8 years). In terms of clinical outcomes for the propensity score-matched cohorts, there was no significant difference in terms of revision rates (1.0 vs. 1.3%, p = 0.76), 90-day emergency department visits (3.0 vs. 3.3%, p = 0.35), 30-day readmission rates (1.0 vs. 1.3%, p = 0.45), and 90-day readmission rates (3.0 vs. 3.6%, p = 0.69). Patients with same-day discharge demonstrated significantly higher postoperative PROM scores, at both 3-month and 1-year follow-up, for PROMIS-10 Physical Score (50 vs. 46, p = 0.028), PROMIS-10 Mental Score (56 vs. 53, p = 0.039), and Physical SF10A (57 vs. 52, p = 0.013). This study showed that patients with same-day discharge had similar clinical outcomes and superior functional outcomes, when compared with patients that had a standard inpatient protocol. This suggests that same-day discharge following TKA may be a safe, viable option in selected total knee joint arthroplasty patients.

Keywords

total knee arthroplasty - same-day discharge - clinical outcomes - patient-reported outcome measures


Publication History

Received: 18 October 2021

Accepted: 15 September 2022

Article published online:
30 December 2022

© 2022. Thieme. All rights reserved.

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